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Background <p>Ventilator-associated bacterial pneumonia (VABP) is a common infection in critically ill patients in intensive care units (ICU), with attributable mortality of up to 13%, and its etiological diagnosis remains challenging.</p> Materials and methods <p>We conducted a multicenter, prospective, observational study within the MULTI-SITA platform to assess the impact on relevant clinical and antimicrobial stewardship outcomes of the use of a molecular syndromic panel (BIOFIRE® FILMARRAY® Pneumonia <i>plus</i>), in addition to a standard approach based on culture. The primary outcome measure was 30-day mortality from VABP onset.</p> Results <p>Overall, 237 patients with VABP were included in the study. In multivariable analysis, SOFA score (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.04–1.22, p = 0.003), previous isolation of carbapenem-resistant <i>Pseudomonas aeruginosa</i> (HR 3.02, 95% CI 1.25–7.32, p = 0.015), and solid neoplasm (HR 2.15, 95% CI 1.12–4.14, p = 0.022) were associated with increased mortality, while no association was registered for the molecular syndromic panel performed (HR 1.07, 95% CI 0.59–1.93, p = 0.825). In secondary analyses, use of the molecular syndromic panel resulted in more events of either de-escalation or initiation of appropriate antibiotic therapy at day 1 from VABP onset in comparison with a standard approach based on culture only (41.3% vs. 27.8%, p = 0.041).</p> Conclusion <p>The use of a molecular syndromic panel in patients with VABP was able to impact antibiotic decisions, without an unfavorable effect on mortality. Further study is necessary to assess the long-term effects in terms of antimicrobial stewardship of molecular syndromic panels-based antibiotic treatment decisions.</p>

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Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study

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  • 发表日期：

    2025年9月25日

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  • Daniele Roberto Giacobbe,
  • Greta Cattardico,
  • Claudia Bartalucci,
  • Vincenzo Di Pilato,
  • Marco Muccio,
  • Alessandro Limongelli,
  • Alessio Signori,
  • Alessandra Bandera,
  • Bruno Cacopardo,
  • Edoardo Campanella,
  • Alessandro Caroli,
  • Annamaria Cattelan,
  • Marta Colaneri,
  • Andrea Cortegiani,
  • Laura Curci,
  • Gennaro De Pascale,
  • Giuseppe Vittorio De Socio,
  • Filippo Del Puente,
  • Antonino Di Fede,
  • Chiara Fanelli,
  • Nicholas Geremia,
  • Maddalena Giannella,
  • Giacomo Grasselli,
  • Chiara Maci,
  • Ivana Maida,
  • Davide Mangioni,
  • Andrea Marino,
  • Maria Mazzitelli,
  • Maria Chiara Meloni,
  • Marco Merli,
  • Elena Momesso,
  • Chiara Oltolini,
  • Carlo Pallotto,
  • Sandro Panese,
  • Matteo Passerini,
  • Emanuele Pontali,
  • Daniele Riccucci,
  • Matteo Rinaldi,
  • Marco Ripa,
  • Vincenzo Scaglione,
  • Francesco Saverio Serino,
  • Vincenzo Spagnuolo,
  • Giulia Spurio,
  • Stefania Tigano,
  • Carlo Torti,
  • Giovanna Travi,
  • Laura Magnasco,
  • Federica Portunato,
  • Federica Briano,
  • Malgorzata Mikulska,
  • Lorenzo Ball,
  • Chiara Robba,
  • Nicolò Patroniti,
  • Denise Battaglini,
  • Mauro Giacomini,
  • Gian Maria Rossolini,
  • Maurizio Sanguinetti,
  • Paola Morici,
  • Anna Marchese,
  • Antonio Vena,
  • Matteo Bassetti,
  • Ylenia Murgia,
  • Gabriele Di Meco,
  • Alice Cappello,
  • Sabrina Guastavino,
  • Cristina Campi,
  • Michele Piana,
  • Sara Mora,
  • Nicola Rosso,
  • Antonio Di Biagio,
  • Giulia Viglietti,
  • Annaflavia Lamarina,
  • Luca De Paola,
  • Stefano Antola,
  • Selene Gallone,
  • Federica Cosentino,
  • Chiara Gullotta,
  • Marco Piscaglia,
  • Federico D’Amico,
  • Serena Sassi,
  • Elena Simoncini,
  • Giacomo Gonnelli,
  • Anna Gidari,
  • Lisa Malincarne,
  • Nicoletta Bobbio,
  • Andrea Parisini,
  • Annalisa Garlaschelli,
  • Sara Grignolo,
  • Fabiola Cammarota,
  • Paola Del Giacomo,
  • Brunella Posteraro,
  • Andrea Lombardi,
  • Antonio Muscatello,
  • Carlo Peri,
  • Mara Tomasello,
  • Nicoletta Boffa,
  • Elena Potenza,
  • Antonella Castagna,
  • Roberta Monardo,
  • Giulia Catalisano,
  • Michela Di Maio,
  • Antonino Giarratano,
  • Mariachiara Ippolito,
  • Pierluigi Viale

摘要

Background

Ventilator-associated bacterial pneumonia (VABP) is a common infection in critically ill patients in intensive care units (ICU), with attributable mortality of up to 13%, and its etiological diagnosis remains challenging.

Materials and methods

We conducted a multicenter, prospective, observational study within the MULTI-SITA platform to assess the impact on relevant clinical and antimicrobial stewardship outcomes of the use of a molecular syndromic panel (BIOFIRE® FILMARRAY® Pneumonia plus), in addition to a standard approach based on culture. The primary outcome measure was 30-day mortality from VABP onset.

Results

Overall, 237 patients with VABP were included in the study. In multivariable analysis, SOFA score (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.04–1.22, p = 0.003), previous isolation of carbapenem-resistant Pseudomonas aeruginosa (HR 3.02, 95% CI 1.25–7.32, p = 0.015), and solid neoplasm (HR 2.15, 95% CI 1.12–4.14, p = 0.022) were associated with increased mortality, while no association was registered for the molecular syndromic panel performed (HR 1.07, 95% CI 0.59–1.93, p = 0.825). In secondary analyses, use of the molecular syndromic panel resulted in more events of either de-escalation or initiation of appropriate antibiotic therapy at day 1 from VABP onset in comparison with a standard approach based on culture only (41.3% vs. 27.8%, p = 0.041).

Conclusion

The use of a molecular syndromic panel in patients with VABP was able to impact antibiotic decisions, without an unfavorable effect on mortality. Further study is necessary to assess the long-term effects in terms of antimicrobial stewardship of molecular syndromic panels-based antibiotic treatment decisions.